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PLECTRICAL PEt,MIT APOLICATr® <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 J (E)everetteps@everettwa.gov J www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 17/ 20 -V7.R,,g, 'tJ.47 r ,,' P <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF p�, t <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTi-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: MA <br /> - <br /> ELE%CTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 4a o--p <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): , e-{ -7 ® 0!_y--' �/7676 "" 2-47 7 <br /> DESCRIPTION OF WORK: f1 t j i i i oitz -THAT /ri -- P/ZJV/o(4 S ppRM)7-- <br /> 17%t) A/' T Fi'V/53--1 <br /> CONTACT INFORMATION . <br /> OWNER NAME: TENANT NAME(if Commercial): ) 6- /t t. <br /> OWNER MAILING ADDRESS: STREET <br /> CnY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Pi I MA '"'"" Lc %g) C / <br /> CONTRACTOR ADDRESS: STREET a//L.�� i?4 AVS 4.../ �^--�0.�-- <br /> CITY ,\IeR:I STATE 1.4f,04 ZIP y(8)2 <br /> CONTRACTOR PHONE: 4- ..-22 41-2- CONTRACTOR EMAIL: / <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER jg CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: fit,,_r ajli�'- 3`�Z <br /> S oviCONTACT EMAIL: <br /> AGREEMENT:T hereby certify th t l have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> off' /-/x E ( oS-2.® <br /> Owner/Authorized Agent Sig ature Date (Revised 10/12/2015) <br />